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variceal bleedingHemorrhage from dilated or variceal veins, usually understood to mean esophageal varices 2º to end-stage liver failure Management-surgical Surgical shunting, endoscopic sclerotherapy, esophageal variceal ligation, transjugular intrahepatic portosystemic stent-shunt–TIPS procedure Management-medical Vasopressin, nitroglycerin, somatostatin, β-blockers, long-acting nitrates. See Transjugular intrahepatic portosystemic stent-shunt–TIPS procedure.
Arterial bleeding may be controlled by applying pressure with the fingers at the nearest pressure point between it and the heart. The artery is located and digital pressure is applied above it until bleeding stops or until the artery is ligated or repaired. When a pressure point is ineffective in controlling arterial bleeding on an extremity, a tourniquet may be needed. See: table
clinically significant bleeding
dysfunctional uterine bleedingAbbreviation: DUB
The absence of the luteal progesterone phase interferes with normal endometrial preparation for implantation or menstruation. Prolonged constant levels of estrogen stimulate uneven endometrial hypertrophy so that some areas slough and bleed before others, causing intermittent bleeding.
menstrual bleedingSee: menstruation
variceal bleedingSee: esophageal varix
Venous bleeding may be controlled by firm, continuous pressure applied directly to the bleeding site. If bleeding is from an area over soft tissues, a large, compress bandage should be held firmly against the site.
CAUTION!A tourniquet should not be used. If the bleeding is over a bony area, as in the case of a ruptured varicose vein of the leg, pressure held firmly against the vein will provide immediate control of the blood loss. The patient should be taken to a health care provider as soon as possible if bleeding does not stop.
|Artery||Course||Bone Involved||Spot to Apply Pressure|
|For Wounds of the Face|
|Temporal||Upward ½ in (13 mm) in front of ear||Temporal bone||Against bony prominence immediately in front of ear or on temple|
|Facial||Upward across jaw diagonally||Lower part of lower maxilla||1 in (2.5 cm) in front of angle of lower jaw|
|For Wounds of the Upper Extremity|
|Axillary||Downward across outer side of armpit to inside of humerus||Head of humerus||High up in armpit against upper part of humerus|
|Brachial||Along inner side of humerus under edge of biceps muscle||Shaft of humerus||Against shaft of humerus by pulling aside and gripping biceps, pressing tips of fingers deep down against bone|
|For Wounds of the Lower Extremity|
|Femoral||Down thigh from pelvis to knee from a point midway between iliac spine and symphysis pubis to inner side of end of femur at knee joint||Brim of pelvis||Against brim of pelvis, midway between iliac spine and symphysis pubis|
|Posterior tibial||Downward to foot in hollow just behind prominence of inner ankle||Inner side of tibia, low down above ankle||For wounds in sole of foot, against tibia in center of hollow behind inner ankle|